The present submission focuses on the psychological and psychiatric co-morbidities of obesity, as well as highlighting the psychological implications of societies contempt towards the obese. We are aware of the ASO submission to this commission and refer to their evidence statement for any general information as indicated in the relevant sections below.

THE HEALTH IMPLICATIONS OF OBESITY

  Obesity is the most common form of malnutrition in the western world (Deitel, 1999) and its prevalence has reached epidemic proportions worldwide. It is not only current levels of obesity that cause concern but also the continuing increase of obesity and the impact this will have on obesity related diseases. Obesity has negative health, social, and economic consequences. It is associated with an increased morbidity and mortality (morbidly obese patients have an estimated 6- to 12-fold increase in mortality), and the development of a number of medical conditions. The National Task Force on the Prevention and Treatment of Obesity (2000) reports an extensive list of obesity related medical conditions. Since these conditions can be expensive to treat, the economic impact of obesity related diseases is substantial.

  The indirect costs arising from the emotional suffering experienced by the obese may be even higher and has been largely neglected to date. Emotional suffering may be among the most painful aspects of obesity. Obesity is associated with extensive social criticism, prejudice, and discrimination on the part not only of the general public but also of health care professionals. Clear and consistent stigmatization and discrimination of the obese have been documented in three important areas of living: employment, education, and health care (Kaminsky and Gadaleta, 2002). As a result, obese people often face prejudice or discrimination in the job market, at school, in social situations, and in the medical community. Given the vast numbers of people potentially affected, it is important to consider the educational, and social policy implications of the deleterious consequences of societies contempt for the obese.

Recommendations

  Like other forms of prejudice, the prejudice against obesity is most likely due to a lack of understanding of the disease of morbid obesity, the root causes and the medical consequences. A plan for continued education of health care professionals and the general public is essential to breakdown the barriers in place due to ignorance and indifference.

  The media and the $30 billion per year diet industry perpetuate the myth that weight (size) is solely under the control of the individual. Efforts by the media to shape societal attitudes and beliefs have been so successful that the industry's biases have penetrated the health care profession. Weight myths exacerbated by the media should be countered.

PSYCHIATRIC HEALTH IMPLICATIONS

  Obese people as a group have similar mental health as normal weight people, and there are no psychiatric features characteristic of obesity in general. However, a sizeable proportion of obese patients suffer from "binge eating disorder", an eating disorder which was included in the DSM-IV in 1994 in an attempt to distinguish binge eating per se without compensatory behaviours from obesity and bulimia nervosa. Despite the fact that 30% of subjects participating in hospital-affiliated weight control programmes (Spitzer et al., 1992; 1993) and 70% of subjects participating in Overeaters Anonymous (Spitzer et al., 1992) have been reported to suffer from binge eating disorder, this disorder is still relatively under diagnosed in the obese population. Binge eating disorder is classified as a psychiatric disorder and requires specialised psychiatric treatment. This diagnosis should be used as a marker for psychological problems that deserve treatment in their own right. Failure to identify, and treat this disorder within the obese population would undermine any kind of weight loss treatment undertaken by the obese patient. It is clear that both the health care professionals and the general public need further education in identifying binge eating disorder as a complication in the treatment of obesity.

Recommendations

  Further education of health care professionals is needed in identifying psychological and psychiatric co-morbidities and sequelae of obesity.

  Obese patients should be screened for binge-eating disorder symptoms.

  Obese patients suffering from binge eating disorder should be referred to specialist eating disorder clinics for treatment of their eating disorder.

TRENDS IN OBESITY

  Trends in obesity are well known and reported widely in other submissions to this committee.

WHAT ARE THE CAUSES OF THE RISE IN OBESITY IN RECENT DECADES?

  Causes of the rise in obesity in recent decades are well documented in the ASO submission to this committee.

WHAT CAN BE DONE ABOUT IT?

  As above.

ARE THE INSTITUTIONAL STRUCTURES IN PLACE TO DELIVER AN IMPROVEMENT?

  We support the submission by the ASO on this matter and would like to highlight the importance of viewing obesity as a multifactorial creature which has risen to epidemic proportions as a result of clusters of changes in our society.

  Obesity is a complicated multifactorial medical disorder with genetic, biochemical, hormonal, environmental, behavioural and cultural elements. Its multifactorial nature begs multidimensional prevention and treatment interventions. In this vein we would encourage the establishment of multidisciplined specialist centres for the treatment of obesity. Furthermore, we would like to draw your attention to the fact that although weight-control programmes have been ineffective in the treatment of obesity, current surgical methods have proved to be effective in helping patients achieve and maintain permanent weight reduction. For optimal results, patients must be carefully selected and treated by a multidisciplinary group, including psychiatrists and psychologists and managed by dieticians, occupational therapists and counsellors. The NICE guidelines have highlighted the cost efficacy of pharmacological and surgical interventions. However, at present many centres do not have adequate resources to implement these guidelines, and many patients who could be helped by successful advances in surgery are left untreated. What is mainly missing is the managerial will.

Recommendations

  Prevention and treatment of obesity requires interventions of a multidimensional nature.

  Multidisciplined specialised treatment centers are required for the effective treatment of obesity. This should include physicians, psychiatrists and surgeons together with counselors, dieticians and occupational therapists.

  Resources need to be realigned to reflect the cost-effectiveness of obesity surgery.

RECOMMENDATIONS FOR NATIONAL AND LOCAL STRATEGY

Recommendations

  We encourage a plan for continued education of the general public and health care professionals to breakdown the barriers in place due to ignorance and indifference.

  Healthcare resources need to be realigned to reflect the dramatic increase and epidemic proportions of obesity and associated co-morbidities and sequelae.

  National strategy should reflect the multidimensional nature of obesity and should be multifactorial in nature.

July 2003